Three Steps to Estimating The Cost Of a Trip To The Doctor

Have you ever went to the doctor and asked yourself, â€œI wonder how much this is going to cost me?â€ Or have you opened a bill from your medical provider only to suffer from a case of sticker shock?

In October of each year I select my medical coverage through my employer for the next year. With health care costs continuously rising, the offerings usually change each and every year. Our health care enrollment package used to come with very specific information for each plan choice regarding what common services would cost the consumer. Try as I might, I can no longer find that information. All I can find is a phone number to call.

A few years ago I had a problem with my feet and went in to see my doctor. Xrays were done, and I assumed they would be covered by my insurance as they had been in the past. When the bill came I found that I was responsible for hundreds of dollars for the Xrays because they were subject to my deductible, which had not yet been met.

Fast forward to this week, I was having an issue that I thought might be a good idea to discuss with a doctor. Being on a budget and having a finite amount of funds available I couldn’t just go to the doctor without having at least a ballpark estimate as to how much it would cost. In the absence of good medical plan documentation I was able to educate myself with information to determine how much my trip to the doctor would cost with the following three steps:

1.) Get Comfortable With Insurance Terms and phrases

Deductible: Amount you have to pay out of pocket for certain medical costs before insurance will pay anything.

Subject to Deductible: Costs that are added to the amount you have paid towards your deductible.

Co-Insurance: Usually stated in the form of a percentage. Example: I have a 20% co-insurance payment for blood work. If the blood work costs $100, insurance pays $80, and I pay $20.

Co-pay: Flat fee paid for a procedure. Example: If I have a $15 co-pay for office visits, I pay $15 for any office visit and insurance pays the rest.

2.) Call Your Medical Provider

Ask to speak to the billing department

Describe the purpose of your visit

Ask how (which code) they will use to bill the visit

Ask if Xrays are commonly done and for a typical cost

Ask if blood work is commonly done and for a typical cost

3.) Call Your Insurance Company

Describe the purpose of your visit

Tell how the office visit will be billed â€“ ask how it would be covered

As how Xrays are covered

Ask how blood work is covered

I walked into the clinic yesterday armed with information. It turned out that no Xrays or blood work was needed, so I ended up with just a diagnostic office visit which is completely covered by insurance. I was prepared, however, to add up the different charges as the doctor recommended them and potentially challenge the necessity if the cost was getting too high.

Do you have detailed information as to what your insurance covers? Do you try to estimate the cost of a trip to the doctor before going?

Brought to you courtesy of Brock

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Comments

This is the base problem with how health care is managed in this country. For most people, having health insurance has insulated us from the cost of health care; thus, most people don’t even think about the cost when making health care decisions. This is the complete opposite from most all other decisions where cost does play a role. And, finding out exactly what something is going to cost in the health care world is next to impossible. The doctors have the rate that they bill people without insurance, then they have the rates negotiated by health insurance companies. The only advice I have (and this has worked for me in the past several times), if you get a bill for something not covered by insurance, call the provider and negotiate. Usually, you can get them to give you the insurance negotiated rate, even if you aren’t in that insurance company’s risk pool.

We’re now in an HMO, so in-network, we only have a $15 copay. Our PPO plan got hideously expensive since Obamacare was passed, so we traded out to save $2500 per year. It’s better in some ways, worse in others. We do see specialists WAY faster than before, and copays even on things like orthodics (which most insurance plans don’t cover at all) are very small.

@Jenny – we actually went in the opposite direction. We used to have an HMO, but the plan became too expensive for my employer so it is no longer an option. Now we have a PPO. I wish we had better orthodontic coverage – my son needed braces but the treatment he needed compared to the increased cost of the insurance to get orthodontic coverage wasn’t worth it.

@James – Let me remind you, just in case you didn’t know exactly how the blogging community works. Bloggers tend to try to help each other out. If someone visits my blog regularly and leaves comments, I make a point to visit their blog. If I like the content I may continue to visit and leave comments as well, not to mention help promote them via social media and/or through weekly roundup posts.